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Print version ISSN 0104-0707

Texto contexto - enferm. vol.20 no.4 Florianópolis Oct./Dec. 2011

http://dx.doi.org/10.1590/S0104-07072011000400001

EDITORIAL

Qualitative
research in health care. Current and future challenges

Dr. Francisco
J. Mercado-Martinez

Doctor, PhD in
Social Science and Research Professor from Guadalajara University (Universidad
de Guadalajara), Mexico. Coordinator of the Qualitative Health Care Research
Program - PROGIECS. Member of the Mexican National Research Association

For many years
now one notes the growing and generalized acceptance of Qualitative Research
in Health Care (QRHC) among the majority of Latin American countries, especailly
in its largest country, Brazil. Proof of this are the publications to be found
under this theme in Text&Context Nursing Journal (Revista Texto &
Contexto Enfermagem). But, parallel to the aforementioned acceptance is
a series of critiques which have been made concerning some of the problems and
challenges faced within this same knowledge production. Based on a recently
published literature review,1 I reference three subjects which are
found at the heart of the debate concerning the contributions and challenges
that qualitative Latin American Health Care Research faces. They are: its theoretical
perspective, the impact of the production generated, and its proposals.

Its theoretical
foundation - the radical adoption and dependence upon pragmatic and empirical
postures, especially the Grounded Theory - seems to be a constant within regionally
produced QRHC. This predominance is found in various forms: as it is the most
employed reference, its respective authors the most cited (Strauss, Glasser,
Corbin, etc.), as well as its designs and strategies the most utilized, beyond
the reoccuring use of computational programs sustained within the same methodology
as Atlas-ti or Nud+ist. The subject should not be the subject of any criticism
at all, at first glance. However, the manner in which it is being used within
the región has resulted not only in production that has little concern
for theory, but also a lack of knowledge and incorrect knowledge on behalf of
other amply used perspectives utilized in latin american countries, such as
those inserted in critical and instigating, not to mention interpretative, paradigms.
In a region characterized by persistence and social inequality, growing social
exclusion processes such as the voices of large social sectors whose exclusion
in the field of health care rights occurs for economic, political, and social
motives, the use of the Grounded Theory and other pragmatic postures seems to
constitute in yet another limitation rather than advance, due to the historical
disinterest in the conditions and circumstances which surround the lives of
the population under study, among many other things.

The impact of the
production generated - until the present moment one cannot find a single study
within the region concerning the impact of qualitative investigation on its
health care systems, organization, or practices. However, some evidence is available
about such impact in academics, especially through the number of times in which
studies have been cited by other researchers. Based on the findings of the aforementioned
literature review, it is an unequal and periphery impact. It is periphery in
the sense that regionally produced qualitative research in health care is not
cited much. It is unequal because the most cited studies are those published
in high impact journals in English, collaborating with authors from developed
nations. There is the need for further literature review which may discover
if this situation occurs across countries or merely in the highly productive
centers of the region; without a doubt, diverse measurements seem to support
the same results. In fact, a topic which seems to strengthen this tendency is
regional scientific policy, above all that from Brazil, Colombia, and Mexico,
as they tend to promote this type of production, especially high impact production
published in English and in Anglo-Saxon journals.2 Many profound
problems arise given a situation of this nature; it is enough to mention two
of them. On the one hand is found the fact the the majority of the QRHS in the
region is published in Spanish or Portuguese and in journals with little or
no impact, as well as in book format. On the other hand, many studies carried
out in the region are not of interest to such Anglo-Saxon journals, not only
because they deal with local topics, but also because there is no theoretical
contribution whatsoever, as highlighted in the previous paragraphs.

To what degree
is there an original contribution from qualitative research in health care?
The theme has not been much debated: but available evidence indicates that the
reported contribution does not occur in terms of proposals which emanate from
published studies. According to the journal mentioned, qualitative studies in
general conclude with common sense proposals, the likes of which are: utilize
the results found; educate health care professionals and the population; or
continue to investigate the theme at hand. Such proposals do not differ in any
way from those derived from studies sustained by other methodologies. However,
they seem to lose the potential that historically has characterized ethnographic,
phenomenological, or ethno-methodological studies, to mention merely three.
The subject is coated in importance not only for academic reasons. In a region
which is characterized by sparking sanitary reforms of a transformational nature,
qualitative research could offer new elements not only to support them, but
also to amplify and strengthen their consolidation.3